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Sentara Health Plans is hiring a Clinical Claims Reviewer/RN for a remote role. This full-time position involves utilization management and post-payment review across various care settings, with RN licensure and coding credentials under...

Secondary Review Nurse At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better.

Beth Israel Lahey Health Primary Care is seeking a Transitional Care Nurse (TCN) to support post-discharge coordination for medically complex patients. This hybrid role starts with onsite training in the North Shore area and emphasizes...

Join the transformative team at City of Hope , where we're changing lives and making a real difference in the fight against cancer, diabetes, and other life-threatening illnesses. City of Hope's growing national system includes its Los Angeles...

A leading healthcare provider is seeking an Associate RN for a remote role dedicated to acting as a care guide and advocate for patients. The candidate must hold a valid RN license in a compact state or California. Responsibilities include...

Psychiatric / Behavioral Health Nurse Job Overview As a Psychiatric / Behavioral Health Nurse, you will help provide comprehensive mental health care for Soldiers, their families, and military retirees. You will also care for those in emotional...

Humana is seeking an Utilization Management Registered Nurse to interpret and support coordination, documentation and communication of medical services and benefit determinations. This remote role reports to the Manager of Utilization Management...

Molina Healthcare Inc in Wisconsin seeks a Registered Nurse licensed in Wisconsin to join as our IRIS Self-Directed Personal Care (SDPC) RN. This remote role partners with individuals enrolled in the Wisconsin IRIS program—providing oversight,...

Centene is seeking a Clinical Review Nurse - Concurrent Review to perform concurrent reviews, assess medical necessity, and contribute to discharge planning. This role supports Medicaid and Marketplace/Ambetter members in a remote setting.

Registered Nurse (RN), Home Infusion We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who...

Case Manager Cedars-Sinai has been named to the Honor Roll for the ninth consecutive year and tied for #1 in California and Los Angeles in U.S. News & World Report's "Best Hospitals 2024-25" rankings, as well as placed among the very best...

Seeking an experienced Registered Nurse Medical Reviewer, the full-time remote position will manage the medical review of complex claims, pre-authorization requests, appeals, and fraud referrals, applying clinical expertise to determine medical...

Job Summary: As the leader of the health care team, provides professional nursing care, utilizing the nursing process in accordance with established standards of care, policies, and procedures. Demonstrates performance consistent...

UnitedHealth Group is seeking an HSS Clinical Coordinator RN to conduct clinical reviews and evaluations related to Medicaid appeals, ensuring compliance and accuracy in assessments. This remote role is ideal for experienced RNs seeking meaningful...

Sentara Health Plans is hiring a Clinical Claims Reviewer RN for a remote role. The position is full-time, 40 hours, with standard hours 8am–5pm EST, Monday to Friday. Remote opportunities are available across many states, including New...

Provides direct nursing care including assessment, plan of care, education, and evaluation for assigned patients. Performs patient duties necessary to maintain the...

UnitedHealthcare in Harlingen, TX is seeking an RN to assess, plan, and implement person-centered strategies while coordinating care across the continuum and advocating for members. The role offers remote work flexibility within a defined...

# Registered Nurse – Remote Triage (Primary Care)Exeter, NH • Exeter Hospital • Full-time • DayShare job:Apply now**When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives.**\\*\\*...

Medix seeks a bilingual Spanish/English LPN/LVN to join a remote healthcare team supporting members through telephonic medication management and outreach. This role suits an LPN who communicates by phone, works independently, and thrives in a...

Humana's Utilization Management Registered Nurse uses clinical nursing skills to interpret and support coordination, documentation and communication of medical services and benefit determinations for post-acute care (SNF, Home Health, DME). You...

Molina Healthcare seeks six TX licensed RNs to work telephonically with Medicaid members across the state. Three roles require at least two years in behavioral health or substance abuse; the other three require two years in ICU/CCU/ED. Most duties...

We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold...

Centene Corporation is seeking a remote Behavioral Health RN reviewer to assess care related to mental health and substance use disorders. You will participate in weekend/holiday rotations and must hold an RN license active in Washington or a...

Case Manager Care Coordinator The Case Manager Care Coordinator coordinates the care and service of patient populations from admission through discharge. The Care Coordinator clinically assesses, plans, implements, coordinates, monitors,...